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1.
J Prosthet Dent ; 2021 Mar 11.
Artículo en Inglés | MEDLINE | ID: mdl-33715833

RESUMEN

STATEMENT OF PROBLEM: Limited information is available on the differences between tissue-level implants with an ultrathin threaded microsurface conical transmucosal portion and bone-level implants rehabilitated with conical custom abutments. PURPOSE: The purpose of this retrospective study was to assess the outcomes of crowns designed as per the biologically oriented preparation technique (BOPT) cemented on conical titanium abutments on tissue-level and bone-level implants. MATERIAL AND METHODS: Patients consecutively rehabilitated with a delayed loading protocol with anterior implant-supported single crowns with a feather-edge margin, in function for at least 4 years, were recruited and divided into 2 groups based on the implant type they had received: tissue-level implants with a conical transmucosal portion or bone-level implants rehabilitated with a conical abutment by following the platform switching concept. Bone resorption, pink esthetic score (PES), and white esthetic score (WES) were collected and analyzed. The nonparametric Mann-Whitney test was performed to analyze all parameters (α=.05 for all tests). RESULTS: A total of 43 participants (48 implants) were included in the present study. The mean follow-up period was 4.5 years (range 52-64 months). A statistically significant difference (P=.004) was found in the mean ±standard deviation bone resorption between tissue-level implants (0.38 ±0.46 mm) and bone-level implants (0.83 ±0.58 mm). Higher values for both PES and WES were obtained in the tissue-level implant group. CONCLUSIONS: Within the limitations of the present retrospective study, tissue-level implants with a conical transmucosal portion seem to provide a suitable alternative to bone-level implants in the anterior area.

2.
Clin Oral Investig ; 2021 Feb 20.
Artículo en Inglés | MEDLINE | ID: mdl-33609186

RESUMEN

OBJECTIVES: This study aims to compare the treatment outcomes of periodontal intrabony defects by using platelet-rich fibrin (PRF) with other commonly utilized modalities. MATERIALS AND METHODS: The eligibility criteria comprised randomized controlled trials (RCTs) comparing the clinical outcomes of PRF with that of other modalities. Studies were classified into 10 categories as follows: (1) open flap debridement (OFD) alone versus OFD/PRF; (2) OFD/bone graft (OFD/BG) versus OFD/PRF; (3) OFD/BG versus OFD/BG/PRF; (4-6) OFD/barrier membrane (BM), OFD/PRP, or OFD/enamel matrix derivative (EMD) versus OFD/PRF; (7) OFD/EMD versus OFD/EMD/PRF; (8-10) OFD/PRF versus OFD/PRF/metformin, OFD/PRF/bisphosphonates, or OFD/PRF/statins. Weighted means and forest plots were calculated for probing depth (PD), clinical attachment level (CAL), and radiographic bone fill (RBF). RESULTS: From 551 articles identified, 27 RCTs were included. The use of OFD/PRF statistically significantly reduced PD and improved CAL and RBF when compared to OFD. No clinically significant differences were reported when OFD/BG was compared to OFD/PRF. The addition of PRF to OFD/BG led to significant improvements in CAL and RBF. No differences were reported between any of the following groups (OFD/BM, OFD/PRP, and OFD/EMD) when compared to OFD/PRF. No improvements were also reported when PRF was added to OFD/EMD. The addition of all three of the following biomolecules (metformin, bisphosphonates, and statins) to OFD/PRF led to statistically significant improvements of PD, CAL, and RBF. CONCLUSIONS: The use of PRF significantly improved clinical outcomes in intrabony defects when compared to OFD alone with similar levels being observed between OFD/BG and OFD/PRF. Future research geared toward better understanding potential ways to enhance the regenerative properties of PRF with various small biomolecules may prove valuable for future clinical applications. Future research investigating PRF at histological level is also needed. CLINICAL RELEVANCE: The use of PRF in conjunction with OFD statistically significantly improved PD, CAL, and RBF values, yielding to comparable outcomes to OFD/BG. The combination of PRF with bone grafts or small biomolecules may offer certain clinical advantages, thus warranting further investigations.

3.
Int J Oral Maxillofac Implants ; 36(1): 103-105, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-33600529

RESUMEN

PURPOSE: Beneficial aspects of short and ultrashort antibiotic administration protocols could be clinically correlated to the reduced side effects on the gastrointestinal microflora. The aim of this Consensus Conference was to establish the necessity of an antibiotic prophylaxis and its dosage to reduce the risk of early implant failure in healthy (ASA 1 or 2), periodontally healthy patients, undergoing basic dental implant surgery (straightforward cases). Additionally, the need for an antiseptic protocol, used before and after the implant surgery, was evaluated. MATERIALS AND METHODS: Active members of the Italian Academy of Osseointegration (IAO), together with several worldwide-recognized key opinion experts in the field of microbiology, implant dentistry, and infectious diseases, were participants at this Consensus Conference. Two systematic reviews were carried out, before the Consensus Conference, and their results discussed in order to give guidelines on the administration of an antibiotic/antiseptic prophylaxis in implant surgery. The systematic reviews covered the following topics: (1) the use of antibiotics to reduce both implant failure rate and peri-implant infections in healthy patients and (2) the use of chlorhexidine compositions capable of reducing complications in patients undergoing surgical interventions. RESULTS: The main statements reached by the assembly were as follows: (1) Rinsing with chlorhexidine is highly recommended before and after implant surgery to minimize the bacterial load. (2) A single dose of antibiotics in straightforward cases is recommended. (3) In complex cases (long surgical time, regeneration procedures), it is advisable to continue the antibiotic administration. CONCLUSION: This Consensus Conference advocates the administration of a unique dose of antibiotics in straightforward implant cases combined with the use of chlorhexidine.


Asunto(s)
Antiinfecciosos Locales , Implantes Dentales , Antibacterianos/uso terapéutico , Antiinfecciosos Locales/uso terapéutico , Fracaso de la Restauración Dental , Humanos , Italia , Oseointegración
4.
Clin Oral Investig ; 2021 Jan 14.
Artículo en Inglés | MEDLINE | ID: mdl-33443685

RESUMEN

OBJECTIVES: The aims of this retrospective study were to report data on the prevalence of retrograde peri-implantitis (RPI) in a single-center in a 20-year observation period and to evaluate implant survival after surgical treatment. MATERIALS AND METHODS: A retrospective cohort study was conducted screening all patients who underwent implant treatment in a private practice. Patients were enrolled if they had one or more implants showing a radiolucency around the implant apex, without implant mobility. Furthermore, clinical symptoms of RPI and days from symptoms' appearance after implant placement were also collected, as well as periodontal and endodontic status of nearby teeth. All patients were treated with the same surgical approach: antibiotic therapy, mechanical curettage, chemical decontamination and xenograft application. RESULTS: Out of the 1749 implants placed, only 6 implants were classified as affected by RPI, with a prevalence of 0.34%. Clinical symptoms of RPI (pain, swelling, dull percussion or fistula presence) varied among patients and were reported after a mean period of 51.83 ± 52.43 days. CONCLUSIONS: RPI was successfully treated with surgical curettage and bone substitute application and all implants are still in place after a mean follow-up of 8.83 ± 5.34 years. CLINICAL RELEVANCE: Bacteria from teeth with failed endodontic treatment or residual lesions might be reactivated by drilling for implant osteotomy, with subsequent colonization of the implant apex and possible failure before prosthetic loading. Therefore, it might be recommended to take a periapical x-ray at implant placement and after 6-8 weeks in order to intercept RPI before prostheses delivery.

5.
Int J Oral Maxillofac Implants ; 35(6): 1149-1158, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-33270055

RESUMEN

PURPOSE: This systematic review aimed to assess the effect of chlorhexidine (CHX) in preventing complications after extractive, implant, and periodontal surgery. MATERIALS AND METHODS: The PICO question set for this systematic review was: "Is the use of chlorhexidine formulations able to prevent complications (safety) in patients undergoing procedures of either oral surgery, dental implantology, or periodontology compared to treatment procedures in patients without a chlorhexidine prescription?" Once inclusion and exclusion criteria were established, a search was carried out independently by two researchers on PubMed/MEDLINE, Scopus, and Web of Science. The primary outcomes investigated were the rate of alveolar osteitis and bacteremia after surgical procedures in oral surgery. Meta-analysis and trial sequential analysis (TSA) were performed in order to evaluate the findings. RESULTS: After the selection, the 32 studies that fully met the eligibility criteria were considered in this systematic review. A meta-analysis was only possible for data obtained from studies related to extractive surgery. Meta-analysis and TSA showed a statistically significant decrease in the rate of alveolar osteitis after tooth extraction when CHX was employed compared with placebo treatments or treatments not using CHX (RR = 0.49; 95% CI: [0.40, 0.60], P < .001; I2 = 8%). Focusing on the rate of bacteremia, meta-analysis and TSA showed how the employment of CHX (RR = 0.87; 95% CI: [0.79, 0.96], P = .004; I2 = 4%) decreases the rate of bacteremia after extractive surgery. Data from the literature seem to lack in the evaluation of CHX use for the reduction of complications in periodontology and implant dentistry. CONCLUSION: This systematic review showed with a good power of evidence that CHX employment reduces alveolar osteitis and bacteremia rates after dental extractions.

6.
J Am Dent Assoc ; 151(12): 956-961, 2020 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-33239159

RESUMEN

BACKGROUND AND OVERVIEW: The authors describe 3 cases of retrograde peri-implantitis associated with residual cysts and their successful surgical and regenerative management. Implants were originally placed with both immediate and delayed protocols. CASE DESCRIPTION: Three patients sought treatment at the authors' specialist private practices with the chief symptoms of pain and swelling in association with implant-retained restorations. Clinical, radiographic, and histopathologic findings supported the diagnoses of infected residual cysts. The lesions were enucleated in toto, the implant surfaces were decontaminated, and bone regeneration procedures were carried out. Long-term recall visits, ranging from 3 through 10 years, confirmed successful retention of all implants treated accordingly. CONCLUSIONS AND PRACTICAL IMPLICATIONS: The authors describe an unusual clinical manifestation and emphasize the role of local procedures during implant placement in areas compromised with infection, cysts, or both and the importance of long-term recall visits.

7.
Int J Oral Maxillofac Implants ; 35(5): 1022-1036, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-32991655

RESUMEN

PURPOSE: This 3-year study aimed to evaluate hard and soft tissue modification around a two-piece implant characterized by a transmucosal hyperbolic neck in healthy consecutive patients with a need for single-tooth replacement. MATERIALS AND METHODS: Two-piece implants (n = 66) were placed with a flapless technique in 56 patients (27 men; 29 women; mean age 55 ± 9 years): 16 immediately after root extraction (immediate group), 20 after 8 to 12 weeks (early group), and 30 after 10 or more months (delayed group). The transmucosal hyperbolic neck was exposed 1 to 1.5 mm above gingival level. Customized abutments were positioned 3 months later with the implant-abutment connection located approximately 1 to 1.5 mm above soft tissue level. Provisional cemented resin crowns were designed with the finishing line at the hyperbolic neck and then positioned to avoid excessive compression of soft tissue, to guide gingival contours. Twenty days later, a definitive metal-ceramic crown was cemented. In all patients, the gingival biotype (thin or thick) was also evaluated. The primary outcomes were as follows: 36-month implant survival rate, peri-implant marginal bone level (MBL, in mm) changes observed in single-blind on radiographs at 1, 3, 6, 12, 24, and 36 months (T1, T3, T6, T12, T24, and T36), and pink esthetic score (PES) at T6, T12, and T36 to analyze soft tissue adaptation after loading and crown application. The secondary outcomes were as follows: plaque score and bleeding on probing (BOP). Linear regression models and multilevel mixed logistic regression were used to detect any statistical difference of MBL according to operative parameters. Kruskal-Wallis one-way analysis of variance (ANOVA) on ranks was performed to assess statistical differences of PES at T6, T12, and T36. RESULTS: The survival rate was 100%. The dropout rate was 1.79%. No infections, mucositis, or peri-implantitis were reported. Implants placed in thick-biotype tissues showed a statistically different lower bone loss at 36 months with respect to the thin biotype (P < .05). At 36 months, the early group showed lower bone loss compared with the delayed group (P < .05). Multilevel mixed logistic regression revealed that gingival biotype was the parameter that was most related to MBL variations (P = .025). The PES value (mean ± SD) at T6 was 10.76 ± 1.19 (median: 11; range: 8 to 13; IQR: 10 to 12). The values statistically increased at T12 and T36, where the mean values were 11.76 ± 1.10 (median: 12; range: 9 to 13; IQR: 11 to 12) and 11.83 ± 1.03 (median: 12; range: 9 to 14; IQR: 11 to 13). CONCLUSION: MBL and soft tissue clinical parameters measured around two-piece hyperbolic-neck implants were stable during the 3-year follow-up and free from complications. The exposure of the hyperbolic neck for 1.0 to 1.5 mm allowed a flapless one-stage surgery, which supported fast adaptation of the soft tissues, evidenced by high PES values and low percentages of BOP. The results from the study imply a new simple approach in the clinical management of gingival and bone tissue.


Asunto(s)
Implantes Dentales de Diente Único , Implantación Dental Endoósea/efectos adversos , Estética Dental , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Método Simple Ciego
8.
J Clin Med ; 9(9)2020 Aug 31.
Artículo en Inglés | MEDLINE | ID: mdl-32878146

RESUMEN

BACKGROUND: Ultraviolet (UV) and non-thermal plasma functionalization are surface treatment modalities that seem able to improve osseointegration. The aim of this systematic review and meta-analysis is to assess the effect of the two methods and possible differences. MATERIALS AND METHODS: The systematic research of pre-clinical animal studies was conducted up to May 2020 in the databases PubMed/Medline, Scopus and the Cochrane Lybrary. A meta-analysis was performed by using the DerSimonian-Laird estimator in random-effects models. RESULTS: Through the digital search, 518 articles were identified; after duplicate removal and screening process 10 papers were included. Four studies evaluating UV treatment in rabbits were included in the meta-analysis. The qualitative evaluation of the included studies showed that both UV photofunctionalization and non-thermal plasma argon functionalization of titanium implant surfaces might be effective in vivo to improve the osseointegration. The meta-analysis on four studies evaluating UV treatment in rabbits showed that bone to implant contact values (expressed as standardized mean differences and raw mean differences) were significantly increased in the bio-activated groups when follow-up times were relatively homogeneous, although a high heterogeneity (I2 > 75%) was found in all models. CONCLUSIONS: The present systematic review and meta-analysis on pre-clinical studies demonstrated that chair-side treatment of implants with UV or non-thermal plasma appear to be effective for improving osseointegration. This systematic review supports further clinical trials on this topic.

9.
Int J Implant Dent ; 6(1): 36, 2020 Aug 13.
Artículo en Inglés | MEDLINE | ID: mdl-32789544

RESUMEN

BACKGROUND: In a previous experimental study, new bone was found growing within granules of HA/ß-TCP. In vitro and experimental studies have shown increased protein adsorption and cell adhesion graft material bioactivated with Argon plasma. The aims of the present experiment were to study new bone ingrowth into ß-TCP/HA granules used as filler material for sinus lifting and the influence on the healing of the bioactivation of the graft with argon plasma. METHODS: Sinus lifting was carried out in 20 rabbits using 60% HA and 40% ß-TCP as filler material either bio-activated with argon plasma (plasma group) or left untreated (control group). The antrostomies were closed with collagen membranes. Biopsies representing the healing after 2 and 10 weeks were collected, and ground sections were prepared for histomorphometric analyses. Various regions of the elevated space were analyzed both around (outer bone; OB) and inside (interpenetrating bone network, IBN) the graft particles. RESULTS: After 2 weeks of healing, 8.2% and 9.3% (n = 10; p = 0.635) of total new bone (OB + IBN) was found in the plasma and control groups, respectively. Small fractions of IBN were found, spreading from the periphery inward of the graft particles. After 10 weeks of healing, the total new bone was 34.0% in the plasma and 31.3% in Control groups (n = 9; p = 0.594). The respective fractions of IBN were 18.0% and 16.0%. New bone was penetrating from the peripheral regions inside the remnants of graft particles, where it was forming a network of bridges in continuity to the remnants of biomaterial through its porosities. The biomaterial decreased in proportion between 2 and 10 weeks from 52.1 to 28.3% in the plasma group, and from 52.5% to 31.9% in the control group. CONCLUSION: The bio-activation with argon plasma on a synthetic graft composed of 60% HA and 40% ß-TCP used as filler material for sinus lifting showed a tendency to improve bone formation; however, the difference with the control group was neither statistically significant nor clinically relevant.

10.
Int J Oral Maxillofac Implants ; 35(4): 731-738, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-32724924

RESUMEN

PURPOSE: To evaluate the influence of bioactivation with argon plasma of a xenograft used as graft material for sinus floor augmentation. MATERIALS AND METHODS: Sinus floor elevation was performed in 20 rabbits using a deproteinized bovine bone mineral as graft material. The xenograft used in the test sites was bioactivated with argon plasma (plasma group), while that used in the control sites was left untreated (control group). Collagen membranes were used to cover the antrostomy. The rabbits were euthanized after 2 and 10 weeks, in groups of 10 each. A histomorphometric analysis was performed in various regions of the elevated space. RESULTS: After 2 weeks of healing, a similar pattern of healing was observed in both groups. New bone fractions were 5.2% ± 2.9% in the plasma group and 5.0% ± 3.5% in the control group (P = .795). In this period, higher amounts of new bone were found in the region close to the sinus bone walls. After 10 weeks of healing, the amounts of new bone within the elevated space increased to 23.5% ± 7.0% and 21.3% ± 7.3% (P = .176) in the plasma and control groups, respectively. The only statistically significant difference was found in the central region, with 20.4% ± 9.7% in the plasma group and 13.2% ± 10.5% in the control group (P = .037). CONCLUSION: The bioactivation of a xenograft using argon plasma improved bone formation within an augmented sinus, especially in the central regions, far from osteogenic sources.


Asunto(s)
Sustitutos de Huesos , Gases em Plasma , Elevación del Piso del Seno Maxilar , Animales , Argón , Matriz Ósea , Trasplante Óseo , Bovinos , Seno Maxilar , Minerales , Conejos
11.
Med. oral patol. oral cir. bucal (Internet) ; 25(4): e449-e454, jul. 2020. ilus, tab
Artículo en Inglés | IBECS | ID: ibc-196495

RESUMEN

BACKGROUND: The aim of the authors was to examine the abutment-fixture interface in Morse-type conical implants in order to verify gaps at this level using a new microscopical approach. MATERIAL AND METHODS: In this in vitro study, 20 abutment-fixture complexes were prepared by sectioning (longitudinal and cross-sectional to the long axis) with a microtome and then with a focused ion beam (FIB). This is a micrometric machine tool that uses gallium ions to abrade circumscribed areas to dig deeper into the cuts obtained with the microtome in order to eliminate cut-induced artifacts. This is because the FIB abrasion is practically free from artifacts, which are normally generated by the action of the microtome blades or other techniques. Samples were then observed by scanning electron microscopy (SEM). RESULTS: The observation of the abraded parts with the FIB permitted measurement of the real gap between the implant-abutment components. A variable amount of gap was retrieved (from 0 to 3 μm) by the observations, confirming the non-hermetic nature of the connection. It has to be pointed out that in approximately 65% of cases, the gap accounted for less than 1 μm. CONCLUSIONS: The reported data confirmed that the analyzed connection system allowed for minimal gap. However, from the evidence of the present analysis, it cannot be assumed that the 2 parts of a Morse-type conical implant are fused in 1 piece, which would create a perfectly matched hermetic connection


No disponible


Asunto(s)
Diseño de Implante Dental-Pilar/métodos , Implantación Dental Endoósea/métodos , Propiedades de Superficie , Valores de Referencia , Microscopía Electrónica de Rastreo , Reproducibilidad de los Resultados
12.
Int J Prosthodont ; 2020 Jun 26.
Artículo en Inglés | MEDLINE | ID: mdl-32589002

RESUMEN

PURPOSE: To evaluate the trueness of two intraoral scanners in different clinical situations and considering operator experience. MATERIALS AND METHODS: Two intraoral scanner systems were used to perform a total of 120 digital impressions of three master casts reproducing three scenarios (single implant, two implants, and four implants [full-arch]). Two operators, one experienced and one unexperienced, were selected. RESULTS: No differences were found between the two operators. A statistically significant correlation was found with regard to the scanning system used and the clinical scenario analyzed. CONCLUSIONS: Within the limits of this preliminary report, operator experience seems not able to significantly influence the trueness of a digital impression; however, imprecision increased in the full-arch cases for both operators. The twoimplant scenario presented similar trueness values for both scanner systems.

13.
Clin Oral Investig ; 24(8): 2543-2557, 2020 Aug.
Artículo en Inglés | MEDLINE | ID: mdl-32591868

RESUMEN

OBJECTIVES: The aim of this systematic review and meta-analysis was to compare the use of platelet-rich fibrin (PRF) with other commonly utilized treatment modalities for root coverage procedures. MATERIALS AND METHODS: The eligibility criteria comprised randomized controlled trials (RCTs) comparing the performance of PRF with that of other modalities in the treatment of Miller class I or II (Cairo RT I) gingival recessions. Studies were classified into 5 categories as follows: (1) coronally advanced flap (CAF) alone vs CAF/PRF, (2) CAF/connective tissue graft (CAF/CTG) vs CAF/PRF, (3) CAF/enamel matrix derivative (CAF/EMD) vs CAF/PRF, (4) CAF/amnion membrane (CAF/AM) vs CAF/PRF, and (5) CAF/CTG vs CAF/CTG/PRF. Studies were evaluated for percentage of relative root coverage (rRC; primary outcome), clinical attachment level (CAL), keratinized mucosa width (KMW), and probing depth (PD) (secondary outcomes). RESULTS: From 976 articles identified, 17 RCTs were included. The use of PRF statistically significantly increased rRC and CAL compared with CAF alone. No change in KMW or reduction in PD was reported. Compared with PRF, CTG resulted in statistically significantly better KMW and RC. No statistically significant differences were reported between the CAF/PRF and CAF/EMD groups or between the CAF/PRF and CAF/AM groups for any of the investigated parameters. CONCLUSIONS: The use of CAF/PRF improved rRC and CAL compared with the use of CAF alone. While similar outcomes were observed between CAF/PRF and CAF/CTG for CAL and PD change, the latter group led to statistically significantly better outcomes in terms of rRC and KTW. In summary, the use of PRF in conjunction with CAF may represent a valid treatment modality for gingival recessions exhibiting adequate baseline KMW. CLINICAL RELEVANCE: The data indicate that the use of PRF in conjunction with CAF statistically significantly improves rRC when compared with CAF alone but did not improve KMW. Therefore, in cases with limited baseline KMW, the use of CTG may be preferred over PRF.


Asunto(s)
Recesión Gingival , Tejido Conectivo , Encía , Humanos , Fibrina Rica en Plaquetas , Colgajos Quirúrgicos , Raíz del Diente , Resultado del Tratamiento
14.
Int J Oral Maxillofac Implants ; 35(3): 485-494, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-32406644

RESUMEN

PURPOSE: The aim of this systematic review was to estimate if an antibiotic prophylaxis regimen reduces implant failure and postoperative infection in healthy patients who are going to receive dental implants. MATERIALS AND METHODS: An electronic database search (MEDLINE/PubMed, Scopus, Web of Science, Cochrane Library) until June 30, 2019, for randomized controlled trials (RCTs) was performed. The Cochrane Handbook for Systematic Reviews of Interventions to assess the risk of bias in individual studies was used. Patient- and implant-level data were extracted for the analyzed outcomes. The risk ratio (RR) and the 95% confidence interval were calculated as meta-analytic effects. A fixed- or a random-effect model was employed on the basis of the presence/absence of heterogeneity (I2 > 50%). Differences between groups were analyzed using the inverse of variance test. The Higgins Index and chi-square test were used to assess the studies' heterogeneity. Additionally, in order to evaluate the power of evidence and to adjust the meta-analytic findings for type 1 and 2 errors, a trial sequential analysis (TSA) was performed. RESULTS: Nine studies including 1,984 patients and 3,588 implants were selected. Eight hundred eighty-five patients (1,617 implants) received no antibiotics or a placebo therapy before the implant surgery; 1,971 implants (1,099 patients) were treated with an antibiotic therapy. The meta-analysis at the patient level showed a statistically significant reduction in the rate of early implant failure associated with the use of antibiotics (I2 = 0%) (RR = 0.32 [0.20, 0.51], P > .001). Similar results were obtained after pooling the implant-level data with the fixed-effect model (RR = 0.33 [0.22, 0.51], P > .001). Such results were also confirmed by the TSA after adjusting for type 1 and 2 errors. CONCLUSION: The results of this systematic review with meta-analysis indicate that an antibiotic prophylaxis prevents early implant failures in the case of healthy patients. No information can be provided on peri-implant infections.


Asunto(s)
Antibacterianos/uso terapéutico , Implantes Dentales , Profilaxis Antibiótica , Fracaso de la Restauración Dental , Humanos , Complicaciones Posoperatorias
15.
Int J Oral Maxillofac Implants ; 35(3): 503-519, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-32406646

RESUMEN

PURPOSE: Abutment soft tissue integration in the transmucosal area supports the peri-implant tissues, improves esthetics, ensures a soft tissue seal against microorganisms, and preserves crestal bone level. The aim of this systematic review was to systematically analyze the cellular response of fibroblasts on different abutment materials and surface modifications in in vitro studies with a score-based reliability evaluation. MATERIALS AND METHODS: A protocol aiming to answer the following focused question was developed: "What is the effect of different abutment materials and different surface modifications on in vitro cellular response of fibroblasts?" A search through three electronic databases (Medline/PubMed, EMBASE, and Web of Science) was performed using the following search terms: fibroblast, implant, abutment used as the main keywords, with AND/OR as Boolean operators. Only in vitro studies using machined titanium as control surface were included. A quality assessment of the selected studies was performed following the SciRAP method. RESULTS: Out of a preliminary pool of 97 articles, 21 relevant articles were identified for final evaluation. Cellular response evaluation was investigated as follows: 10 studies compared two or more different materials, 7 assessed mechanical surface modification, 14 weighed chemical or biochemical surface modification, and 3 evaluated surfaces modified by a biophysical procedure. Rather than abutment bulk material, external surface features (collagen coating, electropolishing, plasma cleaning, and laser dimpling) were demonstrated to positively affect cell response (cell attachment, morphology and proliferations, expression of adhesion-related proteins and cytokines), mostly at the early stage. While sandblasting, acid etching, composite coating, nitride coating, and vitamin D presented lower results compared with machined, controversial results were demonstrated by anodization. The mean reporting quality SciRAP score was 78.17 ± 11.89, while the mean methodologic quality SciRAP score was 84.13 ± 12.35. Intrastudy comparison highlighted that the time after seeding chosen to evaluate the fibroblast response varies significantly and seems to deeply influence the response. In fact, due to heterogeneity in the study designs, statistical methods, and reported results, meta-analysis of the data was not possible. CONCLUSION: Within the limitation due to the design and heterogeneity of the included studies, it can be speculated that abutment material and its mechanical, physical, and chemical modification influence fibroblast response in vitro, especially in the earlier phases of contact with the abutment surface.


Asunto(s)
Implantes Dentales , Titanio , Pilares Dentales , Estética Dental , Reproducibilidad de los Resultados , Propiedades de Superficie
16.
Int J Oral Maxillofac Implants ; 35(3): 585-590, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-32406657

RESUMEN

PURPOSE: The aim of this study was to compare the percentage of tissue types and assess the presence/absence of odontoblasts or preodontoblasts in granulation tissue harvested from lesions associated with teeth extracted due to endodontic and periodontal reasons. MATERIALS AND METHODS: Histologic reports of cases with a confirmed diagnosis (ie, endodontic or periodontal diseases) were included. These should include a semiquantitative analysis of the percentage of tissue types per sample (ie, epithelium, subepithelial connective tissue, bone or chronic inflammation/deep connective tissue). The overall percentage of tissue type per diagnosis was calculated. Quantitative variables were summarized with means and standard deviations. Normal distribution was tested by the D'Agostino-Pearson omnibus normality test. The level of P < .05 was adopted for statistical significance. Finally, an analysis of the salient findings was summarized. RESULTS: The reports from 19 patients were included, 9 of endodontic and 10 of periodontal origins. The granulomatous tissue of endodontic and periodontal disease origin was similar, and consisted mainly of chronic inflammation (endodontic 40%, periodontal 41.7%), followed by epithelium (endodontic 25.7%, periodontal 29.2%), subepithelial connective tissue (endodontic 18.6%, periodontal 20.8%), and bone (endodontic 15.7%, periodontal 8.3%). No significant differences were found when comparing the groups regarding the percentage of tissue types (P ≥ .05). No osteoblasts or preosteoblasts were reported. CONCLUSION: Within the limitations of the study, the granulomatous tissues associated with chronic infection of endodontic or periodontal origin are comparable and consist primarily of chronic inflammatory cells.


Asunto(s)
Enfermedades Periodontales , Humanos
17.
Int J Prosthodont ; 33(3): 297-306, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-32320183

RESUMEN

PURPOSE: To evaluate the effect of different abutment morphologies on peri-implant hard and soft tissue behavior. MATERIALS AND METHODS: The focus question for this literature search was: What are the effects of different abutment morphology (concave vs convex) on peri-implant hard and soft tissue behavior? Randomized clinical trials (RCTs) with a minimum sample size of 20 implants (10 per group) and a follow-up period of at least 3 months after implant loading were considered eligible for this study. This review excluded studies comparing different abutment heights or surfaces and different implant shapes. Two different meta-analyses were performed: one for marginal bone loss (MBL) to evaluate hard tissue changes, and one for Pink Esthetic Score (PES) as an indicator of soft tissue modifications. RESULTS: Four publications from 12 full texts analyzed were included. The meta-analysis (data from 117 patients and 173 abutments) indicated that a statistically significant difference (P < .00001) was detected from the data regarding MBL between the two groups (mean difference = -0.21 [95% CI: -0.25, -0.16]), but not considering the PES (mean difference = -0.69 [95% CI: -2.08, 0.70]) after a minimum period of 3 months after implant loading. All such evidence was confirmed by the trial sequential analysis on both MBL and PES. CONCLUSION: The results demonstrate that abutment design may have an influence on MBL but no impact on soft tissues. However, the existing evidence is moderate, as few RCTs were conducted and follow-up periods were short.


Asunto(s)
Implantes Dentales , Pilares Dentales , Implantación Dental Endoósea , Estética Dental , Humanos
18.
Ann Anat ; 230: 151489, 2020 Jul.
Artículo en Inglés | MEDLINE | ID: mdl-32165207

RESUMEN

BACKGROUND: Plasma of argon was demonstrated to improve protein and cell adhesion on implant surface. On the other hand, increased surface energy and hydrophilicity could potentially amplify the risks of implant surface contamination during clinical phases, risks that have not yet been evaluated in Literature. The aim of the present in vitro study was to verify if Plasma treatment could alter the implant surface characteristics and its ability to remain sterile. MATERIALS AND METHODS: Implants from 9 brands were collected (n=11). One implant for each company was used for SEM surface analysis. To perform the microbiological analysis, ten implants from each company were used and randomly split by allocation either in test or control group. To replicate the surgical work flow, both test and control samples were left 60s in clinical environment. Bacterial growth analysis was performed. Optical density at 600nm was measured as readout of bacterial growth and colony forming unit (CFU) after 24h was evaluated. Statistical analysis was performed by using the Wilcoxon Mann Whitney test. A p-value lower than 0.05 was considered significant. RESULTS: SEM analysis revealed different categories of implant surface roughness. The optical density confirmed a readout of bacterial growth between 4 and 7 with no significant differences within groups. The number of CFU/ml for each measured sample (test and control) was lower than 102 and failed to present significant differences. CONCLUSION: Surface activation using plasma of argon did not affect the degree of implant contamination, allowing to maintain a substantial sterility of the implant independently of its morphology. This may allow in the next future the use of bioactivation through plasma of argon to exploit the superhydrophilicity deriving from this biophysical process.

19.
Int J Oral Maxillofac Implants ; 35(2): 320-329, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-32142569

RESUMEN

PURPOSE: The aim of this study was to compare how two innovative laser titanium surfaces and sandblasted and acid-etched surfaces influence human osteoblast behavior during osteogenesis and the initial phases of bone deposition. MATERIALS AND METHODS: Human osteoblasts from human adipose stem cells were sorted by flow cytometric analysis and induced to differentiate. After 40 days, the osteogenic differentiation was detected by alizarin red staining, and the alkaline phosphatase (ALP) was evaluated with western blot (WB) and real-time reverse transcriptase-polymerase chain reaction (RT-PcR) analysis. After confluence, human osteoblasts were cultured onto two different innovative laser-obtained titanium surfaces (L1 and L2) and compared with one sandblasted and acid-etched (SBAE) surface as the control. At different times, human osteoblast behavior was evaluated with cell proliferation viability assay (MTT), scanning electron microscopy (SEM), energy-dispersive x-rays (EDAX), osteogenic markers with RT-PcR, and WB analysis of matrix extracellular phosphoglycoprotein (MEPE), ALP, and osteocalcin (OCN). RESULTS: After cell sorting, the human osteoblasts from human adipose stem cells showed increasing values of ALP mRNA and protein expression. The osteogenic differentiation was confirmed by quantitative alizarin red staining assay. Profilometric and SEM analysis showed relevant differences between SBAE, L1, and L2 specimens. After 20 days of culture onto titanium samples, SEM evaluation showed a small number of human osteoblasts and isolated sites of bone matrix deposition in SBAE specimens. At the same time, on L1 surfaces, only an osteoblast mono-layer with initial bone deposition was found, while on L2 specimens, there was a thick network with flattened large stellate cells, many cellular interconnections with strong titanium adhesion, and a large complex mineralized structure of crystal bone. After 20 days, for all titanium samples, human osteoblasts culturing EDAX analysis showed the absence of impurities and a higher bone matrix deposition in L2 specimens compared with L1 and SBAE samples. CONCLUSION: The innovative microtopography and nanotopography laser-induced surface showed high biocompatibility with primary human osteoblast cultures and the absence of impurities. The innovative laser texture was capable of influencing the osteogenic process, confirming the critical role of titanium surface characteristics in the cell adhesion and bone deposition during the early phases of osseointegration. The association of human adipose stem cells and titanium surfaces laser-induced with an innovative procedure could generate promising improvements and developments in orthopedics, maxillofacial, and dental implant surgery.


Asunto(s)
Implantes Dentales , Osteogénesis , Diferenciación Celular , Proliferación Celular , Células Cultivadas , Humanos , Microscopía Electrónica de Rastreo , Osteoblastos , Propiedades de Superficie , Titanio
20.
Int J Oral Maxillofac Implants ; 35(2): 330-341, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-32142570

RESUMEN

PURPOSE: To evaluate the factors affecting peri-implant marginal bone level of single platform-switched implants with a smooth neck placed at gingival level (tissue level) using a flapless technique. MATERIALS AND METHODS: Consecutive healthy patients requiring dental implant rehabilitations were enrolled in this study. Titanium implants with a zirconium-oxide-blasted surface and a platform-switch neck tulip configuration were used. Loading was performed 3 months after insertion with a provisional resin crown and after approximately 15 days with a definitive ceramic crown. Peri-implant marginal bone level (MBL) was measured on periapical radiographs at 1, 3, 6, 12, 24, 36, and 48 months by a blinded assessor. The following parameters were evaluated: location (maxillary/mandibular), position (anterior/posterior), sex (male/female), smoke (yes/no), implant placement timing (immediate, early, delayed), gingival thickness (thin/thick), endodontically treated adjacent teeth (yes/no), and diameter (3.8/4.25/5.0 mm). Multilevel analyses exploring factors associated with MBL at 36 and 48 months were performed. RESULTS: A total of 76 patients (42 women, 34 men; mean age: 55.6 ± 10.7 years) received 128 implant rehabilitations. The survival rate was 98.4%. MBL displayed an initial increase during the first months from insertion (preload period). Cumulative mean MBL at T48 was 0.99 ± 0.68, which was not statistically significant from the values at T24 to T36 (P > .05). Mandibular location, delayed implants, and presence of adjacent endodontically treated teeth showed higher bone loss at 36 months (P < .05). Interestingly, at 48 months, only implant placement timing showed statistically significant differences. Delayed implants showed increased bone loss compared with both early and immediate groups (P < .05). Multilevel analysis confirmed the statistical significance of implant location (P = .031; 95% CI: 0.031 to 0.659), endodontically treated adjacent teeth (P = .001; 95% CI: -1.228 to 0.859), and implant placement (P = .045; 95% CI: 0.003 to 0.337) as factors affecting MBL at 36 months. All the investigated parameters, with the only exception being the implant placement group (P = .020; 95% CI: 0.334 to 1.432), were not statistically significant at 48 months (P > .05). CONCLUSION: Platform-switched implants placed nonsubmerged with a flapless approach showed a reduced bone loss progression in the first 4 years, as MBL remained stable at longer times (36 and 48 months). Implants placed with early and immediate timing showed reduced bone loss compared with delayed implants.


Asunto(s)
Pérdida de Hueso Alveolar , Implantes Dentales de Diente Único , Implantes Dentales , Carga Inmediata del Implante Dental , Adulto , Anciano , Coronas , Implantación Dental Endoósea , Femenino , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , Análisis Multinivel , Estudios Prospectivos , Resultado del Tratamiento
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